Advancing post-stroke cognitive rehabilitation through high-frequency neurostimulation: A retrospective evaluation of cortical excitability and biomarker modulation

Abstract

Background: Post-stroke cognitive impairment (PSCI) poses significant challenges to patient independence, yet technological interventions like high-frequency repetitive transcranial magnetic stimulation (rTMS) remain underexplored in clinical neurorehabilitation.

Objective: This study evaluates the integration of high-frequency rTMS into standard care, focusing on its technological efficacy in modulating neuroplasticity and serum biomarkers to enhance cognitive and functional recovery.

Methods: A retrospective analysis of 80 PSCI patients (2021-2023) compared outcomes between a conventional care group (n = 30) and an rTMS group (n = 50) receiving 20 Hz stimulation (YRD-CCY-I device) targeting the dorsolateral prefrontal cortex. Key metrics included Montreal Cognitive Assessment (MoCA), Barthel Index (BI), cortical silent period (CL), central motor conduction time (CMCT), and serum neurotrophic factors (BDNF, VEGF, IGF-1).

Results: Post-intervention, the rTMS group demonstrated superior MoCA scores (19.25 vs. 15.24, p = 0.001), BI (76.36 vs. 70.13, p = 0.001), and IADL (20.38 vs. 18.13, p = 0.001) compared to controls. Neurophysiological markers revealed prolonged CL (25.30 vs. 24.02 ms, p = 0.001) and shortened CMCT (12.05 vs. 12.98 ms, p = 0.001), alongside elevated BDNF (9.56 vs. 7.34 ng/mL), VEGF (156.48 vs. 110.54 pg/mL), and IGF-1 (153.74 vs. 112.90 ng/mL, p = 0.001). Overall efficacy was 94% for rTMS versus 73.33% for conventional care (p = 0.047).

Conclusion: High-frequency rTMS, as a targeted neurostimulation technology, enhances cognitive recovery and cortical adaptability in PSCI by modulating neuroplasticity and upregulating neurotrophic biomarkers. These findings underscore its potential as a scalable adjunct in technology-driven neurorehabilitation programs.

Keywords: Neurostimulation technology; cognitive recovery; cortical biomarkers; stroke rehabilitation; transcranial magnetic stimulation.